FAQ

AIDS stands for acquired immunodeficiency syndrome and describes the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV has been established as the underlying cause of AIDS. The level of immunodeficiency or the appearance of certain infections are used as indicators that HIV infection has progressed to AIDS (see question 4).

Most people infected with HIV do not know that they have become infected. Immediately after the infection, some people have a glandular fever-like illness (with fever, rash, joint pains and enlarged lymph nodes), which can occur at the time of seroconversion. Seroconversion refers to the development of antibodies to HIV and usually takes place between one and two months after an infection has occurred (see question 32).

Despite the fact that HIV infection often does not cause any symptoms, a person newly infected with HIV is infectious and can transmit the virus to another person (see question 7). The way to determine whether HIV infection has occurred is by taking an HIV test (see question 31).

HIV infection causes a gradual depletion and weakening of the immune system. This results in an increased susceptibility of the body to infections and cancers and can lead to the development of AIDS (see questions 2 and 4).

The term AIDS applies to the most advanced stages of HIV infection.

The majority of people infected with HIV, if not treated, develop signs of AIDS within eight to 10 years.

AIDS is identified on the basis of certain infections. Stage 1 HIV disease is asymptomatic and not categorized as AIDS. Stage II (includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections), III (includes unexplained chronic diarrhoea for longer than a month, severe bacterial infections and pulmonary tuberculosis) or IV (includes toxoplasmosis of the brain, candidiasis of the oesophagus, trachea, bronchi or lungs and Kaposi’s sarcoma) HIV disease are used as indicators of AIDS. Most of these conditions are opportunistic infections that can be treated easily in healthy people.

In addition, the United States Centers for Disease Control and Prevention defines AIDS on the basis of a CD4-positive T-cell count of less than 200 per mm3 of blood (see: http://www.cdc.gov/epo/dphsi/print/aids1993.htm) CD4-positive T-cells are critical in mounting an effective immune response to infections.

Post-exposure preventive (PEP) treatment consists of medication, laboratory tests and counselling. PEP treatment must be initiated within hours of possible HIV exposure and must continue for a period of approximately four weeks. Research studies suggest that, if the medication is initiated quickly after possible HIV exposure (ideally within two hours and not later than 72 hours following such exposure), it is beneficial in preventing HIV infection.

For more information, see http://www.who.int/hiv/topics/prophylaxis/en/.

For injecting drug users, certain steps can be taken to reduce personal and public health risks:

• Take drugs orally (change from injecting to non-injecting drug use).
• Never re-use or share syringes, water or drug-preparation equipment.
• Use a new syringe (obtained from a reliable source, e.g. a chemist or via a needle–syringe programme) to prepare and inject drugs each time.
• When preparing drugs, use sterile water or clean water from a reliable source.
• Using a fresh alcohol swab, clean the injection site prior to injection.

• Transmission of HIV from a mother living with HIV to her baby can occur during pregnancy, during labour or after delivery through breastfeeding. In the absence of any intervention, an estimated 15–30% of mothers living with HIV will transmit the infection during pregnancy and delivery. Breastfeeding increases the risk of transmission by 10–15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding.
• Great progress has been made in reducing the number of children born with HIV. The risk of a woman living with HIV passing the virus on to her child can be reduced to 5% or less with effective antiretroviral therapy during pregnancy, delivery and breastfeeding. Primary prevention of new HIV infections among women of childbearing age, coupled with early access to prenatal care and HIV testing, are key to the strategy, with women living with HIV also encouraged to remain on lifelong treatment for their own health (the Option B+ strategy).
• Early infant diagnosis is essential to identify the HIV status of infants and to improve prevention and treatment programmes, as peak mortality occurs between six weeks to four months of age for children who have acquired HIV infection.

Health-care workers should follow universal precautions. Universal precautions are infection-control guidelines developed to protect health workers and their patients from exposure to diseases spread by blood and certain body fluids.

Universal precautions include:

• Careful handling and disposal of “sharps” (items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpels and other blades, knives, infusion sets, saws, broken glass and nails).
• Hand-washing with soap and water before and after all procedures.
• Use of protective barriers, such as gloves, gowns, aprons, masks and goggles, when in direct contact with blood and other body fluids.
• Safe disposal of waste contaminated with blood or other body fluids.
• Proper disinfection of instruments and other contaminated equipment.
• Proper handling of soiled linen.

In addition, it is recommended that all health-care workers take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. In accordance with universal precautions, blood and other body fluids from all people are considered as infected with HIV and other possible viruses, regardless of the known or supposed status of the person.

For more information, see http://www.who.int/hiv/topics/precautions/universal/en/.

There is no cure for HIV. However, there is effective treatment, which, if started promptly and taken regularly, results in a quality and length of life for someone living with HIV that is similar to that expected in the absence of infection.

Antiretroviral medicines are used in the treatment of HIV infection. They work against HIV infection by blocking the reproduction of HIV in the body (see question 4). When a person living with HIV is on effective antiretroviral therapy, they are no longer infectious.

Inside an infected cell, HIV produces new copies of itself, which can then go on to infect other healthy cells within the body. The more cells HIV infects, the greater its impact on the immune system (immunodeficiency). Antiretroviral medicines slow down the replication and, therefore, the spread of the virus within the body by interfering with its replication process in different ways.

Nucleoside reverse transcriptase inhibitors: HIV needs an enzyme called reverse transcriptase to generate new copies of itself. This group of medicines inhibits reverse transcriptase by preventing the process that replicates the virus’s genetic material.

Non-nucleoside reverse transcriptase inhibitors: this group of medicines also interferes with the replication of HIV by binding to the reverse transcriptase enzyme itself. This prevents the enzyme from working and stops the production of new virus particles in the infected cells.

Protease inhibitors: protease is a digestive enzyme that is needed in the replication of HIV to generate new virus particles. It breaks down proteins and enzymes in the infected cells, which can then go on to infect other cells. The protease inhibitors prevent this breakdown of proteins and therefore slows down the production of new virus particles.

Other medicines that inhibit other stages in the virus’s cycle (such as entry of the virus and fusion with an uninfected cell) are currently being tested in clinical trials.

The use of antiretroviral medicines in a combination of three medicines has been shown to dramatically reduce AIDS-related illness and death. While not a cure for AIDS, combination antiretroviral therapy has enabled people living with HIV to live longer, healthier, more productive lives by reducing viraemia (the amount of HIV in the blood) and increasing the number of CD4-positive cells (white blood cells that are central to the effective functioning of the immune system).

For antiretroviral treatment to be effective for a long time, different antiretroviral medicines need to be combined. This is what is known as combination therapy. The term highly active antiretroviral therapy (HAART) is used to describe a combination of three or more anti-HIV medicines.

If one medicine is taken on its own, it has been found that, over a period of time, changes in the virus enable it to build up resistance to the medicine. The medicine is then no longer effective and the virus starts to reproduce to the same extent as before. If two or more antiretroviral medicines are taken together, the rate at which resistance develops can be reduced substantially.

Effective antiretroviral therapy also prevents the transmission of HIV. When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load HIV can no longer be transmitted through sex.

Antiretroviral medicines should only be taken as prescribed by a health-care professional.

An HIV test is a test that reveals whether a person has been infected with HIV. Commonly used HIV tests detect the antibodies produced by the immune system in response to HIV, as they are much easier (and cheaper) to detect than the virus itself. Antibodies are produced by the immune system in response to an infection.

For most people, it takes a month for these antibodies to develop. Antibodies can be found in blood or oral fluid.

Generally, it is recommended that you wait three months after possible exposure before being tested for HIV. Although HIV antibody tests are very sensitive, there is a window period of up to two months, depending on the specific test being used, which is the period between infection with HIV and the appearance of detectable antibodies to the virus. In the case of the most sensitive anti-HIV tests currently recommended, the window period is about three weeks. This period may be longer if less-sensitive tests are used.

During the window period, people infected with HIV have no antibodies in their blood that can be detected by an HIV test. However, the person may already have high levels of HIV in their body fluids, such as blood, semen, vaginal fluids and breast milk. HIV can be passed on to another person during the window period even though an HIV test may not show that they are infected with HIV.

Knowing your HIV status has two vital benefits. Firstly, if you are HIV-infected, you can start treatment promptly, thereby potentially prolonging your life for many years (see question 36). Secondly, if you know you are infected, you can take all the necessary precautions to prevent the spread of HIV to others (see question 13). If you are not infected with HIV, you can learn how to protect yourself from HIV in the future

There are many places where you can be tested for HIV: in the offices of a private doctor, a local health department, hospitals, family planning clinics and sites specifically set up for HIV testing. Always try to find testing at a place where counselling is provided about HIV. You can also take an HIV test in privacy by using an HIV self-test kit. However you should go and see your health-care provider in the event of a positive test result for confirmation and seeking appropriate treatment.

All people taking an HIV test must give informed consent prior to being tested. The results of the test must be kept absolutely confidential.

There are different types of testing available:

Confidential HIV test: the medical professionals handling the HIV test keep the result of the test confidential within the medical records. Results cannot be shared with another individual unless written permission is provided by the person tested.

Anonymous HIV test: the tested person’s name is not used in connection with the test. Instead, a code or number is assigned to the test, which allows the individual being tested to receive the results of the test. No records are kept that would link the person to the test.

Shared confidentiality is encouraged and refers to confidentiality that is shared with others, who might include family members, loved ones, caregivers and trusted friends. However, care should be taken when revealing the results as it can lead to discrimination in health-care and professional and social settings. Shared confidentiality is therefore at the discretion of the person who will be tested. Although the result of the HIV test should be kept confidential, other professionals, such as counsellors and health and social service workers, might also need to be aware of the person’s HIV-positive status in order to provide appropriate care.

Thanks to new treatments, people living with HIV can now live long, healthy lives. It is very important to make sure you have a doctor who knows how to treat HIV. A health-care professional or trained HIV counsellor can provide counselling and help you to find an appropriate doctor.

A negative test result means that no HIV antibodies were found in your blood at the time of testing. If you are negative, make sure you stay that way: learn the facts about HIV transmission and avoid engaging in unsafe behaviour.

However, there is still a possibility of being infected, since it can take up to three months for your immune system to produce enough antibodies to show infection in a blood test. It is advisable to be retested at a later date and to take appropriate precautions in the meantime. During the window period, a person is highly infectious, and should therefore take measures to prevent any possible transmission.

HIV is not spread by mosquitoes or other biting insects. Even if the virus enters a mosquito or another sucking or biting insect, it cannot reproduce in the insect. Since the insect cannot be infected with HIV, it cannot transmit HIV to the next human it feeds on or bites.

There is no evidence that HIV can be transmitted while playing a sport.

HIV is not transmitted by day-to-day contact in social settings, schools or the workplace. You cannot be infected by shaking someone’s hand, by hugging someone, by using the same toilet or drinking from the same glass as someone living with HIV or by being exposed to coughing or sneezing by an infected person (see question 7).

No. Anyone who has condom-less sex, shares injecting equipment or has a transfusion with contaminated blood can become infected with HIV. Infants can be infected with HIV from their mothers during pregnancy, during labour or after delivery through breastfeeding.

You cannot tell if someone has HIV by just looking at them. A person infected with HIV may look healthy and feel good, but they can still pass the virus to you. An HIV test is the only way a person can find out if he or she is infected with HIV.

Yes, you can have more than one sexually transmitted infection at the same time. Each infection requires its own treatment. You cannot become immune to sexually transmitted infections. You can catch the same infection over and over again. Many men and women do not see or feel any early symptoms when they first become infected with a sexually transmitted infection; however, they can still infect their sexual partner.

If the antiretroviral therapy is effective and the virus is fully suppressed, you cannot transmit HIV to others. For this reason, monitoring of the suppression of the viral load is recommended as part of ongoing care for people living with HIV.